Important Medicare Fraud Numbers for 2011

February 14, 2012

This morning, DoJ and HHS released a new report showing key numbers regarding healthcare fraud prevention efforts in 2011. Apparently, 2011 was both a banner year for heatlhcare fraud and correspondingly healthcare fraud prevention. Sorting through the report, the following numbers stand out:

4,100,000,000 = total number of dollars recovered from healthcare fraud.

2,400,000,000 = number of healthcare dollars recovered under the False Claims Act, including whistleblower actions.

6,600,000,000 = number of dollars collected under False Claims Act for healthcare fraud since 2009.

1,430 = number of new indictments for health care crimes in 2011.

743 = number of defendants convicted of healthcare crimes in 2011.

21 = number of criminal convictions involving the pharmaceutical industry.

1,300,000,000 = number of dollars recovered for pharmaceutical fraud.

47 = average number of months in prison for healthcare fraud convicts in 2011.

350,000,000 = the number additional dollars allocated to Healthcare Fraud prevention in 2011.

9 = number of cities with Medicare Fraud Strike Force Teams

Analyzing these numbers, two propositions emerge: (1) there is a lot of healthcare fraud; and (2) we need to dedicate a lot more time, energy, and resources to fighting it. Both propositions are seemingly obvious in their foundation notwithstanding the factual basis found in the recent DoJ report. A closer look at the facts further demonstrates the need to allocate resources to fraud prevention efforts. According to the report every dollar spent on healthcare fraud prevention over the past three years has netted more than $7 in fraud recoveries – an astoundingly efficient use of taxpayer dollars compared to the inefficiencies of the healthcare system itself. An estimated ten to twenty-five cents of every federal healthcare dollar is lost to fraud.

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